# Inside out: a rare case of nonpuerperal uterine inversion caused by submucosal leiomyoma

## TL;DR

A rare case of nonpuerperal uterine inversion caused by a submucosal leiomyoma is reported, highlighting diagnostic and treatment challenges.

## Contribution

This paper presents a unique clinical case of NPUI caused by a submucosal leiomyoma, contributing to the limited literature on the condition.

## Key findings

- NPUI was diagnosed in a 50-year-old woman with a protruding vaginal mass and absence of cervix and uterus on ultrasound.
- Uterus repositioning was performed vaginally and abdominally, followed by total abdominal hysterectomy.
- Conservative management is rare, and hysterectomy is often necessary after repositioning.

## Abstract

Nonpuerperal uterine inversion (NPUI) is an extremely rare condition characterized by the uterus turning inside out through the endometrial cavity or cervix. Due to its rarity, NPUI presents diagnostic and therapeutic challenges, especially in atypical cases. This report discusses the management of such a case. A 50-year-old woman, P1A0, was referred with a protruding mass from her vagina. With no cervix part identified and no uterus found on abdominal ultrasound, uterine inversion with submucosal leiomyoma was diagnosed. Repositioning was done from the vagina and abdomen using a sondage. Total abdominal hysterectomy was performed. NPUI is a rare condition often caused by uterine fibroids, presenting with vaginal bleeding, pain, and a protruding mass. Diagnosis of uterine inversion relies on clinical signs, ultrasound, or magnetic resonance imaging could help but is not essential. Treatment depends on reproductive goals, but often requires hysterectomy following uterus repositioning. Conservative approaches are rare, and their impact on fertility remains uncertain.